Individual
MR. VICTOR MACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
98 GUM LN, AUBURN, CA 95603-5511
(530) 823-5893
(530) 823-5471
Mailing address
PO BOX 7504, AUBURN, CA 95604-7504
(530) 823-5893
(530) 823-5471
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
N0782128
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MTN00600F
MEDI-CAL
CA
Enumeration date
11/06/2007
Last updated
11/06/2007
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